Abstract
A 64-year-old man with cholangiocarcinoma near the porta hepatis underwent resection of the left hepatic lobe, caudate lobe, and extrahepatic bile duct. No postoperative complications occurred, and he was discharged home on day 13 after surgery. However, on day 27, he developed abdominal pain and was brought by ambulance to our hospital. Melena and shock occurred later that day, emergency angiography was performed, and rupture of a proper hepatic artery pseudoaneurysm was diagnosed. Other than the hepatic artery, no arterial collaterals to the residual liver were identified, so coil embolization of the proper hepatic artery was performed for hemostasis.
To ensure arterial blood flow to the residual liver immediately after embolization, anastomosis of the ileocolic vessels and arterioportal shunting were performed. There were no further postoperative complications, and after arterial collaterals to the residual liver were confirmed on day 64, the ileocolic artery was coil embolized.
Monitoring of possible complications such as portal hypertension is of course necessary. However, combined embolization and arterioportal shunting for rupture of a postoperative hepatic artery pseudoaneurysm after hepatectomy is an effective treatment strategy to prevent postoperative ischemic liver failure.
